Hospitals alerted to possibility of 'anesthesia awareness'

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Carol Weihrer talks to a group at the Trinity Methodist Church, in April in Virginia. Weihrer is speaking out about anesthesia awareness after her experience of feeling her surgery under general anethesia during an eye operation.

MCLEAN, Va. — The pain in Carol Weihrer’s eye was so severe she decided to have it surgically removed, believing it was the only way to get on with life.

Instead, the surgery was the beginning of an unending nightmare. Her anesthesia failed, leaving her awake but paralyzed for a five-hour surgery in which doctors cut and gouged to remove her right eye.

“You feel really grueling pulling on your eye, but you can’t move to relieve the pressure,” Weihrer said recently.

She felt no pain from the cutting, because the painkilling portion of the anesthesia was effective. But the tremendous pressure exerted to remove the eye was painful in its own way.

“You’re sure you’ll die if you can’t let them know you’re awake, she said. “And you think, ’That’d be fine, too, as long as this ends. And then you think, ’Maybe you did die ... and maybe you’re in hell.”’

Since her ordeal in 1998, which brought her an out-of-court settlement, she has suffered from post-traumatic stress disorder, and sleeps in a chair because lying down triggers the feelings of fear and helplessness.

Weihrer, who lives in Reston, has since dedicated her life to warning of the dangers of anesthesia awareness and agitating for changes in how doctors monitor a patient’s consciousness.

Undue fear?She has won significant attention in the medical community, but some anesthesiologists worry her campaign may be causing undue fear.

Roger Litwiller, a Roanoke anesthesiologist and president of the American Society of Anesthesiologists, said it’s important to keep the issue in perspective — that awareness during surgery occurs only in about one or two of every 1,000 procedures.

That perspective can sometimes get lost, he said, when people hear horror stories like Weihrer’s.

“We meet people at a time when they’re very vulnerable,” he said. “They don’t need a whole lot of extra things to worry about.”

Rates of women who are opting for preventive mastectomies, such as Angeline Jolie, have increased by an estimated 50 percent in recent years, experts say. But many doctors are puzzled because the operation doesn't carry a 100 percent guarantee, it's major surgery -- and women have other options, from a once-a-day pill to careful monitoring.

Even so, a hospital accreditation organization plans to issue an alert to hospitals about anesthesia awareness.

Robert Wise, of the Joint Commission on Accreditation of Healthcare Organizations, has spoken with Weihrer several times about the issue. Since there are an estimated 20 million surgical procedures a year requiring anesthesia, even an incidence rate of 0.1 or 0.2 percent translates into a significant problem.

“If you’re one of those people, it’s a pretty awful side effect” that can trigger later problems like post-traumatic stress disorder, Wise said.

In addition to giving interviews, Weihrer has taken her campaign directly to doctors. She has also testified on behalf of death-row inmates facing lethal injection, who are executed using some of the same drugs that caused Weihrer’s problem. That has led to concern from some that the inmates are awake, paralyzed and possibly in extreme pain for several minutes before they die.

The technology, approved by the Food and Drug Administration, is called a bispectral index (BIS) monitor. The theory is that if a patient is awake but paralyzed, it will show a high level of awareness to alert the anesthesiologist to adjust the medication and put the patient to sleep.

Litwiller contends the research is inconclusive on a BIS monitor’s usefulness to an anesthesiologist.

Peter Sebel, anesthesiology professor at Emory University, led a study last year that estimated 100 patients a day experience some form of awareness during general anesthesia.

Sebel said it’s hard to know exactly how many cases of awareness are relatively minor, such as coming to just as surgery ends. But in severe cases, “it appears to affect people in a very nasty way,” he said.

At George Washington University Hospital in Washington, doctors have been using the BIS monitors in the operating room for several years. Last year they expanded use to the intensive care unit for monitoring heavily sedated patients, said Barbara Jacobs, the hospital’s director of critical care.

“We want to make sure you’re not feeling anything,” Jacobs said. “It does not replace a human being monitoring your vital signs, but it is another tool we have to make sure you are properly sedated.”

Weihrer said in her surgery — a step she took because of recurring problems from a rare cornea condition — the worst part was her inability to move. “It’s like being entombed,” she said.

Sebel said he is perplexed by the Society of Anesthesiology’s cautious approach to the use of monitors.

“Anesthesiologists have their head in the sand,” he said. “I find the profession’s attitude to this puzzling.”

Citing several studies, Sebel contends the BIS monitor can reduce incidents of awareness by more than 80 percent. But Litwiller says the studies, including Sebel’s, are suspect because they were financed by the monitor’s manufacturer, Aspect Medical Systems.

“I am concerned that in addressing this issue we use good science that is not biased in any way,” Litwiller said.

Aspect Medical says its monitors are available in about 30 percent of hospital operating rooms, but their use varies widely. The machine itself costs about $9,500, and the single-use monitors cost $17.50 each, according to the company.